I have fat pads that remain after a lower bilateral lower blepharoplasty and canthopexy. Any suggestions? (photos)

Question

I had this procedure performed on January 7, 2015. It appears there was no problem with the canthopexy surgery on both eyes, but my lower left eye has fat pads. I looked better before the surgery. The plastic surgeon is not making himself responsible for the poor result. Fortunately, I am going to my former employer in Hawaii to have a revision which he recommended in six months. .

Kenneth D. Steinsapir, MD · Answer

Your lower eyelids have been compromised by the transcutaneous lower eyelid surgery.  It is true that the fat remove was not ideal.  However, your issues are far beyond that.  The lower eyelids are vertically short and have actually pull the lateral aspect of the upper eyelids down.  I hope your former employer is expert in the repair of unsatisfactory eyelid surgery.  This is highly specialized work.  I believe that you actually need a hand carved orbital rim implant to support the mid face, a hard palate graft to control the lower eyelid shape, trimming of the orbital fat that was left uneven and lateral canthoplasty.  Generally this work is done one eye at a time.  It is important that the eyelid have a definitive correction because half measures only use up resources that are needed for a definitive repair.

John J. Martin, Jr., MD · Answer

You have some residual fat pads on the left side.  Since your surgeon most likely did a fat excision blepharoplasty, you will want to get these trimmed to achieve some symmetry.  I would not say that the canthopexy was a success. In this pictures your eyelids are pulling down and you have some of the sclera showing.  At 6 months this should be revised to try and elevate the lid to its normal position.  You should see an oculoplastic surgeon as this is not an easy revision.

Ira Vidor, MD · Answer

Hi. I agree that you have residual fat pads on the left side, and it looks like there is residual on the right as well. It also looks like you have developed lid retraction as well. I agree that you would benefit from revision surgery. Aside from fixing the residual fat pads, it looks like you need the lower lids raised and supported. That will require a lower lid spacer graft and mid face work as well. In addition, you probably need a revision of the lateral canthus. These types of cases can be complicated, and usually performed by an oculoplastic surgeon that is experienced in revision eyelid surgery. Best regards, Ira Vidor, M.D.

Patrick Flaharty, MD FAACS · Answer

Residual fat pockets under the eyelids after lower eyelid surgery is not uncommon and generally easy to fix with a secondary procedure to remove the additional fat.  Once fat is removed from the lower eyelid the remaining fat can migrate into the vacant area creating a new bulge.  Generally it is only a small amount of additional fat that needs to be removed to resolve the bulge or full area.  My recommendation is to return to the operative surgeon to discuss.  No one is more motivated to make you happy than the surgeon who did the initial procedure.  Generally these "touch up" procedures are done with little or no additional charge.

Costas Papageorgiou, MD, FACS · Answer

Thank you for the posting. I assume the procedure involved fat excision rather preservation/transposition. The left asymmetry is likely related to incomplete/asymmetric excision of the medial and lateral fat pockets. Possible lower eyelid malposition. Revisional blepharolasty surgery is a very sensitive procedure and I strongly recommend  that you consult with someone who specialises in eyelid surgery.

Jason J. Hall, MD, FACS · Answer

Your pictures are difficult to interpret because of the angle at which they were taken.  You have some asymmetry between the right and left lower lids, though.  If your primary surgeon doesn't feel that there is anything that can be corrected, seek a second opinion - an in-person examination and discussion of what you see the problems are can help guide any secondary surgery that you may have.

Donald Nunn, MD (retired) · Answer

You do have some residual fat pad herniation that could be improved.  You also need more support of your lower eyelids which are bowed inferiorly.  This may require additional canthal surgery for the added support.   Find a surgeon who does frequent revision eyelid surgery for the best result.  Good luck.  Donald R. Nunn MD  Atlanta Plastic Surgeon

I have fat pads that remain after a lower bilateral lower blepharoplasty and canthopexy. Any suggestions? (photos)

Answers (7)

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